Teresa Maples, MS LMHC CSAT CMAT
(253) 271-4896
3208 50th St Ct NW
Suite100
Gig Harbor, WA 98335
USA
FORMS

If you're a new client, please complete the following forms and bring them to your first session.

  • Patient Registration
  • Confidentiality/Cancellation Policy Form
  • Psychosocial Assessment

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form:

  • Disclosure and Authorization Form

 

 

          Patient Registration
 
 

Consent Form
 
Disclosure Authorization  
Psychosocial Assessment  

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